Double-fortified salt (DFS), which carries iodine and iron, is being promoted as a population-scale fix for anaemia.

A public health analysis warns that iron alone is no solution, and that DFS should not be scaled up nationally without more groundwork.

• The burden: NFHS-5 found that 57% of women aged 15 to 49, 52.2% of pregnant women, 59.1% of adolescent girls and 67.1% of children aged 6 to 59 months are anaemic.
• The argument for DFS: Everyone eats salt, so adding iron is convenient and affordable.
• The counter-argument: Convenience is not efficacy. DFS depends on steady salt intake, which pulls against India’s goal of cutting salt.
• The proposal: First run monitored district pilots, use targeted fortification with better-absorbed iron, and invest in diagnostics, deworming, sanitation and diverse diets.

• Salt reduction: Indians eat about twice the WHO’s 5 g limit, and about one in three adults has hypertension. The NCD action plan aims for a 30% cut.
• Wrong people get the most: Adult men eat the most salt, while young children and women eat the least.
• Iron can harm: The body cannot excrete excess iron. The 2006 Pemba trial linked iron to more hospitalisations and deaths in children in a malaria area, and a 2015 Kenyan trial linked it to harmful gut bacteria and diarrhoea.
• Blood disorders: People with thalassaemia risk iron overload, and screening about 800 million PDS users is impractical.
• Stacking: Children may already get iron from fortified rice and iron-folic acid tablets, with no study of total intake.
• Poor absorption: Non-haem iron is blocked by phytates, tea, coffee and calcium, and by infection, through the hormone hepcidin.

• Only part of the cause: The CNNS (2016-18) found iron deficiency explained only part of anaemia in children and adolescents.
• Other causes: Folate and B12 deficiency, infections, hookworm, malaria, poor sanitation, blood disorders, undernutrition and early pregnancy.

• Anaemia Mukt Bharat: Launched in 2018. The 2026 revision moves from 6×6×6 to 7×7×7, adding low birth weight babies as a seventh group, “Eating Right” and digital tracking.
• Gaps: Heavy reliance on iron-folic acid tablets, little routine testing for ferritin and B12, weak focus on deworming and sanitation, and tracking of tests instead of outcomes.
• Peru and Vietnam: Peru cut child anaemia through named tracking and cash transfers, and Vietnam used weekly iron-folic acid, deworming and better-absorbed fortified fish sauce. Neither relied on one fortified food.

• Health: Anaemia harms cognition, productivity and maternal and child outcomes.
• Policy: The debate tests whether single-nutrient fixes fit multi-cause problems.
• Public trust: Large rollouts need evidence on safety and effectiveness.

• Multiple causes need different responses, and tests are costly.
• Poor compliance with iron tablets.
• Weak sanitation and infection control.
• Data gaps on cumulative iron exposure and harm.